Before Teen Is Prescribed Opioids, Look at Family's Drug Use

And new research shows that when a teen is prescribed an opioid painkiller after minor surgery, his or her odds for long-term abuse nearly doubles if someone living at home already has an opioid use problem.

The study of more than 300,000 people averaging 17 years of age found that after being prescribed an opioid painkiller for post-op pain, 4.1 percent went on to use the drug long-term if another person living in the family home had already been using opioids long-term.

That's compared to just 2.4 percent of young patients without such histories, said researchers led by Dr. Jennifer Waljee, from the University of Michigan Medical School.

"Physicians should screen young patients for long-term opioid use in their families" before issuing a take-home prescription for the painkillers, the researchers advised.

Waljee and her colleagues said the finding is in line with similar studies conducted in adults.

Prior research shows that "a family history of substance use is a potent risk factor for opioid misuse in relatives," the researchers noted. For kids in particular, "permissive family norms and exposure to substance use among parents and siblings" are also strongly tied to drug abuse in adolescents, Waljee's team added.

The findings were published Feb. 27 in JAMA Surgery.

In the study, Waljee and her group used data from insurance claims to track opioid usage for over 346,000 patients aged 13 to 21 who'd never been prescribed an opioid before. These young people typically received a short course of the painkillers (such as OxyContin or Vicodin) after a routine surgical or dental procedure.

Long-term, continued use of an opioid by a family member -- defined as filled opioid prescriptions for four months or more over the past year -- was also recorded.

The issue of opioid abuse "running in the family" is not new. In fact, Columbia University researchers reported Monday in the journal Pediatrics that teenagers were 30 percent more likely to abuse prescription opioids if one of their parents had done so before.

Dr. Robert Glatter is an emergency physician at Lenox Hill Hospital, and he has seen the ravages of opioid abuse firsthand. He said preventing addiction in the first place is key, and the new study shows doctors have a big role to play.

"It's essential that surgeons strongly consider and advocate for nonopioids when prescribing pain medications after surgical and dental procedures in adolescents and young adults," Glatter said. Drugs such as NSAIDs (ibuprofen, for example) may provide even better pain relief, he said, without the risks.

And if post-op pain persists longer than the usual seven days, "it's important to make sure there are no surgical complications, while also conducting an evaluation of the nature of the pain itself," Glatter said.

In any case, before prescribing a teens any opioids, "it's vital that medical providers inquire not only about a family history of substance abuse, but about family members with long-term opioid use," he said.

Dr. Harshal Kirane directs addiction services at Staten Island University Hospital in New York City. He agreed that the new study "highlights the importance of systematic screening of patients prior to initiation of opioid therapy -- and identifies a new risk factor that clinicians should be aware of."